Healthcare Provider Details

I. General information

NPI: 1346295128
Provider Name (Legal Business Name): UROPARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S WILLOW SPRINGS RD STE 380
LA GRANGE HIGHLANDS IL
60525-6539
US

IV. Provider business mailing address

5201 S WILLOW SPRINGS RD STE 380
LA GRANGE HIGHLANDS IL
60525-6539
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-2550
  • Fax: 708-354-4552
Mailing address:
  • Phone: 708-354-2550
  • Fax: 708-354-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD HARRIS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 708-450-5055